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Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists

Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is uncl...

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Autores principales: Savioli, Gabriele, Ceresa, Iride Francesca, Luzzi, Sabino, Gragnaniello, Cristian, Giotta Lucifero, Alice, Del Maestro, Mattia, Marasco, Stefano, Manzoni, Federica, Ciceri, Luca, Gelfi, Elia, Ricevuti, Giovanni, Bressan, Maria Antonietta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353902/
https://www.ncbi.nlm.nih.gov/pubmed/32585829
http://dx.doi.org/10.3390/medicina56060308
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author Savioli, Gabriele
Ceresa, Iride Francesca
Luzzi, Sabino
Gragnaniello, Cristian
Giotta Lucifero, Alice
Del Maestro, Mattia
Marasco, Stefano
Manzoni, Federica
Ciceri, Luca
Gelfi, Elia
Ricevuti, Giovanni
Bressan, Maria Antonietta
author_facet Savioli, Gabriele
Ceresa, Iride Francesca
Luzzi, Sabino
Gragnaniello, Cristian
Giotta Lucifero, Alice
Del Maestro, Mattia
Marasco, Stefano
Manzoni, Federica
Ciceri, Luca
Gelfi, Elia
Ricevuti, Giovanni
Bressan, Maria Antonietta
author_sort Savioli, Gabriele
collection PubMed
description Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery.
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spelling pubmed-73539022020-08-05 Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists Savioli, Gabriele Ceresa, Iride Francesca Luzzi, Sabino Gragnaniello, Cristian Giotta Lucifero, Alice Del Maestro, Mattia Marasco, Stefano Manzoni, Federica Ciceri, Luca Gelfi, Elia Ricevuti, Giovanni Bressan, Maria Antonietta Medicina (Kaunas) Article Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery. MDPI 2020-06-23 /pmc/articles/PMC7353902/ /pubmed/32585829 http://dx.doi.org/10.3390/medicina56060308 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Savioli, Gabriele
Ceresa, Iride Francesca
Luzzi, Sabino
Gragnaniello, Cristian
Giotta Lucifero, Alice
Del Maestro, Mattia
Marasco, Stefano
Manzoni, Federica
Ciceri, Luca
Gelfi, Elia
Ricevuti, Giovanni
Bressan, Maria Antonietta
Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists
title Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists
title_full Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists
title_fullStr Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists
title_full_unstemmed Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists
title_short Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists
title_sort rates of intracranial hemorrhage in mild head trauma patients presenting to emergency department and their management: a comparison of direct oral anticoagulant drugs with vitamin k antagonists
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353902/
https://www.ncbi.nlm.nih.gov/pubmed/32585829
http://dx.doi.org/10.3390/medicina56060308
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